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In England NowA Running Commentary by Peripatetic Correspondents
LIFEMANSHIP, the whole Potter saga, is certainly wellknown to the medical student of today. I hope it is
equally familiar to his examiners. For I have just finishedmy quarterly stint at Queen Square on the " wrong "side of the green-baized table. And I have been muchentertained by the ties of the more practised candidates.The conversation goes something like this : " So youfound sugar in that specimen of urine, did you ? " ;"Yes, sir ; so of course I thought of diabetes "-this forthe sixth time that morning. My mind begins to slip abit. It is clear to me that the candidate, a muscularbronzed type with well-developed thenar muscles whichhe keeps nervously contracting, obviously wishing hehad a jib-sheet in his hands, knows for the moment,anyhow, all about anything I know about diabetes.The room is hot; I am probably a bit hypoglycaemic ;I slip further and find myself saying, as I am sure hemeant me to find myself saying, " Is that a sailing-club tie ? " Of course it is : it is a dark-blue tie sprinkledwith small colourful burgees. " Yes, sir. It’s theSt. Columba’s Deep-sea Cruising Club tie." " So youtake a boat out of coastal waters, do you ? " I findmyself saying, though I have really had not the slightestinterest in ocean cruising for the past 25 years. It isjust that my interest in diabetes mellitus has reachedits nadir.A green tie with crossed skates, or a dark-red tie with
hockey sticks, can have the same effect on me. I amcommitted temporarily-and gratefully-to a conversa-tion about something which interests the candidateprofoundly and which has nothing whatever to do withmedicine. Or is that so ? This is a qualifying examination- and to hear the candidate telling me about how hetook his 5-tonner inside Ushant may give me a betteridea of how he would handle a patient in a sticky situationthan would his recitation of what the registrar taughthim in the revision course last week about treating apatient in diabetic coma.My examining partner seems to be more interested in
the heraldic ties and this, I must say, I deplore. It seemsto me to get us nowhere.
" Is that a pelican on your tie ? "
he asks. " Yes, sir," says the expert in tiemanship,‘‘ Corpus Christi, sir." "I know," says my partner,"Were you up when Jenkins was the senior tutor ?
" No, sir ; he died in college the term before I went up."A clever gambit this, for it induces my partner to give aclinical lecture on the pathology of Jenkins’s cerebro-vascular degeneration, which, it seems, he superintendedfor some years.
! But tiemen should not wear a current hospital tie,unless they are prepared to stand up to strictly topicalbowling-" U.C.H. tie, I see. Well, tell me, who wasRothera ? " " St. Thomas’s. Tell me about Clutton andhis joints." " A Guy’s tie, is it. Well-what do you knowabout Bright, Addison... ?
* * *
So now, gentle student, you have decided to read the
I light relief from all that advice about where to go and, what to do. But you have not learned the half of it yet,! my boy. If you want to be the smooth consultant with
shiny car and all the trimmings, you must plan now to’ Get On. Remember that you must get into the right, jobs and gather the right letters at the right times. Then
your chief will get you that job : his brandy and cigars, will do more than your own white collar and hair-cut.
Comes the consultantship, with 30 or more up for it.. They have all written papers, had lots of experience,
harvested the proper diplomas, and hold forthright andacceptable opinions about private practice (desirabilityof), psychosomatic medicine, and the Minister of Health.
! They all glow with the same glow. So what decides ?‘ " That chap Smith ... a clever fellow by all accounts.
Sometimes, a bit too clever, don’t you think ? YoungBrown, now ... he is one of Tom Sniffle’s boys. I knowTom. He wouldn’t sell us a dud ... "
E As soon as you can, find your Sniffle and get going.Keep your face in front of him on rounds, let him rag yougently in outpatients. Check up on his pet subjects, andthen at a quiet moment in the pub give him another
drink and " I saw a case of spondulips today, Sir. Atleast I think it was. Would the serum whatsit distinguishit ..." Then sit back while Sniffle tells you about allhis cases of spondulips, and goes through his theory ofcausation, to the time that old Squeak missed an obviouscase.
If you decide to go academic, the game is much thesame. Just shift emphasis to being very scientific aboutthings. Learn to criticise others, but don’t be too causticabout the Sniffle group itself. When you can spot theresearch band-waggon, jump on it, and ride along inthe crowd, talking down the passers-by. Keep close to thedrivers, argue with them but don’t worst them in public.
Either way, it’s useful to have something you can beknown for and be expected to talk about. Find your littletopic and flog it, inside out and upside down. Anythingwith a fashionable sound to it will do-something like" the serotonin content of big-toe-nails in 200 unselectedcases, and its variations in the shod and the unshod."This will get you in as a serotonin expert, a toe-nailexpert, with a message for dermatologists, pharmaco-logists, physiologists, surgeons (remember crush injuriesof toes), industrial M.o.s, physicians, police surgeons,&c., &:c. You should easily produce the two papers a yearthereon ; and remember to speak frequently in anydiscussion involving serotonin and/or toe-nails.Of course, if you can marry Sniffle’s daughter, much
of this may be redundant.* * *
The obituary of a distinguished pathologist remindedme of my oral examination when he was externalexaminer. The old man was very deaf and used anelaborate hearing-aid which had a battery contained in abox like a small wireless set. It was rumoured that, whenlosing interest in a conversation, he would switch off hismachine in order to save the battery.
During the examination I was becoming aware that Iwas not doing well. The professor then pushed towardsme a bottle containing an ulcerated bowel and, whiledeciding whether to put my money on typhoid or tubercu-losis, I was horrified to see his hand stretch towards theelectric box which had been laid on the table. In amoment there was a loud click followed by a terriblesilence. Fearfully, I looked up ; the external examinerwas gazing through the window in serene appreciationof the Pentland Hills.But I passed-three months later.
* * *
Dr. Magnus Pyke finds a lot of unconscious humourin science. From his new book, we learn that highlyqualified colloid chemists are devoting their talents andthe fruits of long training to prevent the pulp in orangesquash from settling to the bottom of the bottle. Andwe are reminded of our old friend the Dalmatian coachhound, the one and only mammal (other than manand the higher apes) which excretes uric acid instead ofallantoin : most curiously, in a kennel in the UnitedStates, it was found that only pure-bred Dalmatianscould be trained to run under the back axles of buggies,and the ability to learn this was related to the anomalyof excreting uric acid instead of allantoin.
Discussing the value of insects in our diet, Dr. Pyketells us that in the 8th century B.C. King Asurbanipal,who lived in a palace near Nineveh, served his guestswith locusts arranged on sticks, and there is apparentlygood evidence that the manna which fed the Childrenof Israel was supplied by aphids. For vegetarians whodo not care for a diet of insects, the possibility of algreas a source of food seems worth considering and Dr. Pykerecommends the cultivation of algae as a method ofproducing food in the artificial satellites of the future.
It is comforting to learn that the theory that thehippopotamus is the only animal which does not havecholesterol in its bile is entirely in error and is due to amisphrased sentence in the first textbook on the subject,
. setting off a rumour which was passed from book to
. book. One further curiosity from pharmacology mightbe added to Dr. Pyke’s list : it is reported that aninhibitor to the toxin of the nettle has recently been
extracted-from dock-leaves.*We refer to Dr. Pyke’s book Nothing -Like Science in an annotation,
on p. 415.—ED. L.